Provider Demographics
NPI:1649734344
Name:VOGT, TAYLOR
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:VOGT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BOW BOG RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-4001
Mailing Address - Country:US
Mailing Address - Phone:603-748-9421
Mailing Address - Fax:
Practice Address - Street 1:135 BOW BOG RD
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304-4001
Practice Address - Country:US
Practice Address - Phone:603-748-9421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer